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Infection in a functioning ventriculoperitoneal shunt treated with intraventricular gentamicin
Insights
High-dose intraventricular gentamicin sulfate successfully treated a ventriculoperitoneal (VP) shunt infection in an infant. This approach achieved therapeutic cerebrospinal fluid (CSF) levels, offering a potential treatment strategy for similar infections.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
- Pharmacology
Background:
- Ventriculoperitoneal (VP) shunt infections are a serious complication in hydrocephalus management.
- Enterobacter cloacae and Klebsiella pneumoniae are common causative agents of shunt infections.
- Establishing effective antibiotic concentrations in cerebrospinal fluid (CSF) is crucial for treatment.
Observation:
- A four-month-old infant with hydrocephalus developed a VP shunt infection.
- Initial treatment with intravenous antibiotics was insufficient; subsequent cultures revealed Enterobacter cloacae.
Findings:
- High-dose intraventricular gentamicin sulfate (up to 6 mg/day) combined with intravenous carbenicillin achieved therapeutic cerebrospinal fluid (CSF) gentamicin levels.
- A second infection with Klebsiella pneumoniae was treated with intraventricular gentamicin and intravenous chloramphenicol.
Implications:
- This case demonstrates the potential efficacy of high-dose intraventricular gentamicin for treating VP shunt infections.
- Achieving therapeutic CSF gentamicin levels is possible with adjusted intraventricular dosing in patients with patent VP shunts.
Abstract:
A case of successful treatment of a functioning ventriculoperitoneal (VP) shunt infection with high doses of intraventricular gentamicin sulfate is reported. The VP shunt reservoir of a four-month-old girl with hydrocephalus became infected. The scalp wound was debrided and intravenous methicillin sodium, 200 mg every six hours, was administered. When culture and sensitivity tests later showed Enterobacter cloacae, methicillin was discontinued. Intraventricular gentamicin, 2 mg/day, and intravenous carbenicillin, 400 mg/kg/day, were administered. Gentamicin dosage was increased twice over the next eight days to 6 mg/day. The trough cerebrospinal fluid (CSF) gentamicin level at 2 mg/day was 1.7 micrograms/ml, at 4 mg/day was 0.7 microgram/ml and at 6 mg/day was 19.6 micrograms/ml. Gentamicin was discontinued after 14 days; carbenicillin was continued for 7 more days. For a second shunt infection with Klebsiella pneumoniae, intraventricular gentamicin and intravenous chloramphenicol were given for 21 days. Previous reports of ventricular shunt infections are reviewed. The report indicates that it is possible to achieve therapeutic CSF levels of gentamicin in patients with patent VP shunts by administering 2--5 times (depending on ventricle size) the usual intraventricular dose.